Senators seethe at IHS blunders

Michael Weahkee, a Public Health Service offers, is the acting head of the IHS. He was on the hot seat at a Senate hearing Wednesday. (Image from hearing video on Senate.gov)

President Trump proposes to cut the Indian Health Service budget by $300 million, and the head of the IHS had trouble defending that 6 percent cut at a Senate hearing Wednesday. Sen. Lisa Murkowski, who chaired the hearing, said the IHS is already failing Native communities in the Lower 48. She wasn’t the only senator outraged by the state of IHS, and it goes well beyond the budget.

Michael Weahkee, the acting IHS director, would have had a rough hearing anyway. Chairman Murkowski and other members of the Interior Appropriations Subcommittee have spent years shaping the IHS budget. Some represent large Native populations. They weren’t likely to welcome cuts to drug treatment, mental health services, clinics and hospitals in their states.

But just last week, the Wall Street Journal put a spotlight on the agency’s dire faults.

Murkowski said she was horrified to read the Journal’s accounts of fatal misdiagnoses, under-treatments, over-treatments and inept staff at IHS facilities in the Great Plains.

“Because this is our IHS. These are our facilities that are supposed to care for our first people,” Murkowski said. “And the stories that were detailed were shocking ”

(Murkowski said she’s normally laser-focused on home-state issues, but Alaska’s Native health facilities are run by tribes, under contract to the IHS, so their problems aren’t the same.)

Sen. Steve Daines, a Montana Republican, suggested changing the name of IHS to “Indian Health Suffering.”

“These are real families – single moms, single dads, aunts, uncles, elderly tribal leaders -that are suffering greatly,” Daines said. “It’s a tragedy.”

Weahkee acknowledged none of this in his statement at the hearing. He portrayed the proposed cut to his agency as small.

“Which will allow us to maintain and address our agency mission to raise the physical, mental, social and spiritual health of American Indians and Alaskan natives to the highest level,” Weakhee said.

Murkowski was incredulous.

“I know that your job is to defend this budget but I just I just have to say ‘wow,'” Murkowski said. “After listening that, I would think that we don’t have a problem within the IHS system”

Several senators were frustrated IHS didn’t provide data on Medicaid reimbursements, the revenue IHS gets when it treats a Medicaid recipient. Murkowski said the information is important, because senators are supposed to vote soon on a health care bill that would cut Medicaid, and they won’t know the effect it would have on IHS.

Sen. Jon Tester, D-Montana, was among those who nearly begged Weahkee to advocate for his agency’s needs. Tester sounded calm when he started the questioning, but he noticed a pattern of non-answers.

“Were you told not to answer any questions here, by the way?” Tester asked.

Weahkee said no.

“OK,” Tester said. “Because I think it’s absolutely unbelievable that you can’t separate how much Medicaid has helped you with third-party billing.

Tester spent a long time trying to get the acting director to answer one specific question: “What does this budget do to your ability to hire staff?”

“We have a lot of efforts under way,” Weahkee said.

Tester calmly persisted:Is there an increase in dollars for hiring staff or decrease?”

We prioritized maintaining direct-care services,” Weahkee said.

Tester asked at least six times and grew furious with the opaque responses.

I’m going to tell you something. Indian Health Service is in a crisis!” Tester said, by then shouting. “And if you have served in Indian Health Service for 10 years and you have answered the questions in Indian Health Service like you have today, it’s no wonder that it’s in crisis! I cannot believe what has transpired in this hearing today! All I want is some damn answers!

The White House hasn’t yet nominated anyone head IHS permanently. Health Sec. Tom Price said at his confirmation hearing he was aware of problems at IHS and wanted to fix them.